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Myelodysplastic syndromes (MDS) are characterized by ineffective hematopoiesis in one or more hematopoietic lines with abnormal morphology and peripheral blood cytopenia. Primary MDS are more common in elderly patients and rare in children and young adults. The diagnosis of MDS in patients with unexplained cytopenias requires careful morphologic evaluation of both the peripheral blood and bone marrow cells. To examine which abnormalities detected by routine examination suggest MDS, we analyzed the hematological findings of peripheral blood in seventy-six cases of MDS. Anemia (> 60%), leukopenia (> 40%), thrombocytopenia (> 70%) as well as blast (> 40%) were often found. The prevalence of MDS was relatively high in patients with morphological abnormalities such as elliptocyte, dacryocyte, erythroblast, pseudo-Pelger-Huet anomaly, decreased secondary granules and giant platelets. Careful attention should be paid to these findings especially elderly patients, since these may provide clues to the diagnosis of MDS.